[pronut-hiv] New Hope for HIV Mothers

["ProNut-HIV" <pronut-hiv@healthnet.org>]

New Hope for HIV Mothers
African Woman and Child Feature Service (Nairobi)

March 9, 2006 
Arthur Okwemba
Nairobi 

Initial results from a study being carried out in Kisumu indicate that a
new drug intervention could allow HIV-positive mothers to breastfeed
their babies without infecting them.

Researchers from the Centres for Disease Control of the US and Kenya
Medical Research Institute have recruited 348 women out of an expected
520, but preliminary results indicate a much lower incidence of
mother-to-child HIV transmission among the study group.

"We are seeing exciting results that are likely to work for the good of
the women. But I can't give you the detailed statistics because we have
yet to finish analysing data," says Tim Thomas, head of HIV research at
the Kemri research station in Kisumu.

Antiretroviral drugs

Studies in African countries show that when the drug Nevirapine is given
as a single dose to HIV-positive women at the onset of labour, chances
of a mother passing the virus to the baby are reduced from 40 to 12 per
cent.

The Kisumu study wants to reduce this figure further to six per cent,
significantly cutting down the possibility of the child getting
infected.

To reduce mother-to-child transmission, antiretroviral drugs are
administered at 33 weeks of pregnancy and just before the onset of
labour.

Women with CD4 counts of more than 250 are given Combivir and Nelfinavir
while those with less than 250 are put on Combivir and Nevirapine. CD4
stands for immunity cell count of a patient, which normally should be
500. If the number falls below that, you become susceptible to
infections.

Those taking the drugs continue do so for six months after delivery,
during which they continue to exclusively breastfeed.

Studies elsewhere have shown that HIV-positive mothers who exclusively
breastfed for at least three months were less likely to infect their
babies than those who introduced other foods and fluids during the
period.

Breastfeeding

The use of drugs in the Kisumu study is designed to lower the amount of
the virus in the woman's body and consequently reduce the risk of
infecting the baby.

After six months, mothers with a strong immunity cell count - more than
200 - are discontinued from both drugs and breastfeeding. But they are
monitored for up to two years to assess the performance of their immune
systems.

Those whose cell count is still low by the end of six months are asked
to stop breast feeding but continue taking drugs for up to two years.

Babies born to these mothers are monitored to determine whether they are
infected and, if so, they are put on medication. But once mothers are
out of medication they are advised not to breastfeed at all and start
the children on solid foods.

But the study has had its downside: some 24 subjects have 'absconded'
midway supposedly after being discouraged by their husbands and other
family members. Those interviewed by the researchers cited husbands as
being key to their decision.

"Although we ask women to come along with their husbands during the
antenatal clinics as a way of getting the support of the husband, it is
not mandatory," says Thomas.

Maternal clinics

In the past, organisations that have tried to make it mandatory for
women to be accompanied by husbands to maternal clinics have seen the
effort backfire. Many women either stopped attending subsequent sessions
or opted not to visit such centres at all.

The researchers in the Kisumu study are nevertheless upbeat that a good
number of the 348 women who are still participating in the study are
accompanied by their husbands to the clinics.

All in all, Thomas says the study is sensitive to recommendations by the
US Food and Drug Administration on the use of Nevirapine following
indications that the drug posed a high risk of damage to the liver. "We
had seen some mild side-effects in our volunteers who were on Nevirapine
but we have since put these on other medication," says Thomas.